De-escalation from Dose-Intensified Anti-TNF Therapy Is Successful in the Majority of IBD Patients at 12 Months.

Abstract

BACKGROUND:

Data on outcomes following de-escalation of intensified anti-TNF therapy in inflammatory bowel disease (IBD) are limited and concerns about relapse limit willingness to de-escalate.

AIMS:

To evaluate rates of successful de-escalation at 12 months and to determine factors that may predict success.

METHODS:

Single-centre experience of IBD patients that were de-escalated following deep remission on dose-intensified infliximab (IFX) or adalimumab (ADA) for secondary loss of response. Patients were classified as 'successes' if remaining on reduced anti-TNF or 'failures' if requiring re-escalation, steroids, surgery or enrolment into a clinical trial at 12 months. Patient demographics, disease characteristics, biomarkers (faecal calprotectin, C-reactive protein, albumin) and anti-TNF drug levels were collected 6-monthly.

RESULTS:

Of 25 patients (20 CD, 5 UC), 16 (64%) were successes 12 months post-de-escalation. Median time to failure was 6 months. Six of the nine failures required anti-TNF re-escalation and three entered a clinical trial. Re-escalation recaptured response in all six patients. There was no significant difference in baseline biomarker activity between the two groups. There was no difference in infliximab levels between successes and failures at the time of de-escalation (5.5 vs. 5.3, p = 0.63) as well as 6 months (3.1 vs. 4.6, p = 0.95) and 12 months (3.2 vs. 4.5, p = 0.58) post-de-escalation.

CONCLUSION:

Nearly two-thirds of patients remained on reduced anti-TNF dosing 12 months after de-escalation. All patients who failed de-escalation were recaptured after dose re-escalation. De-escalation with close monitoring may be considered in patients on intensified anti-TNF therapy in sustained remission.

• Authors: Robert D Little, Isabel E Chu, Mark G Ward, Miles P Sparrow
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 67 Issue 1 Pg. 259-262 (01 2022) ISSN: 1573-2568 [Electronic] United States
• PMID: 33763785 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Biomarkers
• Tumor Necrosis Factor Inhibitors
• C-Reactive Protein
• Infliximab
• Adalimumab

Topics

• Adalimumab (administration & dosage, immunology)
• Adult
• Biomarkers (analysis)
• C-Reactive Protein (analysis)
• Colitis, Ulcerative (drug therapy, immunology)
• Crohn Disease (drug therapy, immunology)
• Dose-Response Relationship, Immunologic
• Drug Monitoring (methods, statistics & numerical data)
• Drug Tapering (methods, statistics & numerical data)
• Duration of Therapy
• Female
• Humans
• Infliximab (administration & dosage, immunology)
• Male
• Recurrence
• Remission Induction (methods)
• Treatment Outcome
• Tumor Necrosis Factor Inhibitors (administration & dosage, immunology)